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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • • COMMUNITY DEVELOPMENT Permit #: ELR2009 -00238 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009 Parcel: 2S 110AA00200 Jurisdiction: Tigard Site address: 14130 SW 105TH AVE 21 Subdivision: CANTERBURY TERRACE APARTMENTS Lot: 0 Project: Canterbury Terrace Project Description: Install fiber optics for Verizon. Owner: FEES Description Date Amount VOIEN, BETH TRUST BY BETH VOIEN TR, 24 VILLA POINT DR Restricted Energy Permit 07/31/2009 $75.00 NEWPORT BEACH, CA 92660 12% State Surcharge - Electrical 07/31/2009 $9.00 PHONE: Contractor: PHONE: FAX: Type of Use: MF Class of Work: ALT Total Number of Systems: Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: Y Fire Alarm: N HVAC: N Instrumentation: N Total $84.00 Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through RAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. � �,1 Issued By: l Q I Jl Permittee Signature: $J.._-Q_ - *PP OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. :. RECEIVED JUL 2 9 2009 CITY OF TIGABi Electrical Permit Application BUILDING DIVI' IF& &VICEUSEONLY'';' "."` '•` °, .; t City of Tigard P �:R .� r. r 0' i 13125 SW Hall Mid., Tigard, OR 97223 Plan Rev+cw Plume! 503.639.4171 tax: 503.598.1940 uacrny: O11ur Yeama: TIGARD Inspection Line: 503,639.4175 0aleRcadyffy: I Ed See PnxcZtor interact: www.tigmtl- or,gav Nuilft di todnnt: Supplemental (nrarmattua ... . - TYPE 'PP WORK ",.. .. • :,• . .. PLAN REVIEW. `i:•• .... . . 0 Newuonstmetion 4 Addition/alteration/replacement ' ' Piease cheek all tam apply 0unnut;setsni'nlaos*Memulteeket howw: p$11tOlitioO 0 Other: or feeder 401) mops ,u mote (J 0u0niuy over Mc rto,ivi. whorl, no bwli+ntlte rhbll 111/10111 a Marines amt Mlmyvds. ' '`.. ': •:,..: :' ,., " :: % .::::1,:. - CATEGORY •Or: CONSTRUC74ON . ., , .., +moats 1000 amps RI ISO win ur 13 (haling boitdiuys, nail dwelling less to Iowa or exceeds 14,000 C7 Commercial-ago agdcniturat 1 - and 2 -i y G OColmttu'clal /industrial ❑Accessorybuilding` amps l'or all other lima Rations. buildings, GI Multi 0 Master builder ❑Oilier: !aFilo Iamyl. O h} ilinionof .. 400 '•J00 'SITE• IN0?ORMATUON AND LOCATION `:i ' "` . ❑emepelwyry «w1n Iorycra :pnraleyrMstmn. ..••.•. � .-• • C]MWit ❑,,,� ",SRS ",•,Lt "t,•,1,1.' rlvtd ry Job no.: I lob alto RW1'03 : 14130 SW 105TH AVE 166$41 ormnro. ncettpaney. 0Si< more residential anal, ❑ Rc Reareuilouel vehicle padot. City /StateZIP: TIGARD, OR 97224 CI Resl h•carc facilities. Cl Supply voli gc far nwro than ❑ Haa i toitt locations, (1110 wan mminnl. Suite/bldg./Rix, no, 21 - 24 , Pi jcotnxnle: CANTERBURY TERRACE l7 Serv&bw feeder 600umapsur more . — _ :,....:.,.: :.•'s..'. ..FEE •:. Cross street /directions to job site: ' narripnaa I Otr. I Yee. I 'thud 1 • -- New residential single. or ntuhl•famlty dwelling wilt. Wanks 'Recited garage. Subdivision: Lot no.: 1.000 sq. 11. or less 145.15 4 Tax map/parcel no.: ea. add'I 500 sq. II. or iwnion 33.40 1 __ l Jailed energy, resilitias' 75,00 2 DESCRIPTION OP WORK (with tm lot, It,) INSTALL FIBER OPTICS FOR VERIZON Ln revident al (with l�iunavenlNI83 75.00 = Services or feeders inslai ntion mailer Moodien 200 amps or less 80.30 2 • • .''0 PR0PI RTTY'0WNPSR •• • "'I :, • . - '.Q' TENANT ' ` . 201 amps to 400 maps 106.85 2 Name: 401 AMISS to 600 amps 160.60 2 801 amps to 1,000 amps 240.60 2 Address: Over 1,000 maps or ooh — 2 City /State/ZIP: Temporary services or feeders Installation, alteration, and/or relocation Phone: ( ) Fnx: ( ) 200 amps or less 66.8$ I Owner Installation: This installation is being made on property that t own whit is not 201 mn w to 400 amps 100.30 2 intended for sate, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Drench circuits- new, snot ()wan' signature: _.__Date: C , © A PPL ICANT A. Pao for branch cireuus with ••'! :t • • • r4 • ' • �.CONTACf PE RRO • above Wotan to (seder Ito, G.GS 2 • each branch cheek . Rusinetw name: NORTH SKY COMMUNICATIONS, INC. IL Pee for brunch oircuita Contact name: ERIK SCHENCK wow/ 46,$5 2 I irsl broach circuit Address: 11818 SE MILL PLAIN BLVD STE. 410 ti :achadd'l circuit 1 -- 6.65 -- 2 Miscellaneous (service or feeder nal included) City /State/ZIP: VANCOUVER, WA 98684 Eon muntClctarcd " . dweuine, service atdfor feeder 9090 2 Phone: (503 ) 969 -7729 I Fax: : ( 866 ) 452 -4853 Reconnect only - 66.85 2 G •mail :_mduorCrDncrthskycomm.com Pump orinipstion circle 53.40 2 . CON`CRA("f0R ' ' • - Sign or outline il8hdng 53.40 2 Business mune: NORTH SKY COMMUNICATIONS, INC. energy panel, erlhtli. or miargy panel, ahorutial. or Address: 11818 SE MILL PLAIN BLVD. STE 410 extension, Describe: 1 Paget $75.00 2 City /StatclZIP: VANCOUVER, WA 98684 Bad additional Inspection over allowable inittn1 the above Phone: (360) 254 -6920 I Fax: ( ) 1-866-530-4325 Iat GtvessigstigaMton , • 62.50 ntin ntrcrlwurl7 62.50 CCB Lie.; 14117 Electrical Lie.17 -154CL : Stym. Lie.: 173LEB Industrial pinot per bow 73.73 I / . .• 'ELECTRICAL PERMIT PEES •- •••" Suprv. Electrician signature, requited: r .. • $75.00 a �l Submits: Print panne: JACK CAGLE Date: 7/29/09 Plan review (25% of permit foe): �� State surcha (t2% of permit ice): $9,00 Authorized signature: la�sAa> 4 e!' TOTAL PERMIT PEE: _ $84.00 Print name: ETHAN A. DOL PH 1 � _ Date: 7/29/09 Igo math apMtran maim aim Ira wont is not obtained attain 180 ' days after It tau bred noceptad as coaniac. • Nulnbel or ha Mane .liosvtd pwittll, InladialnyW ,04411a,C•NrofaApp,,Me OS/23/06 7 .1n- (1I5r(tfm.VWOIAV69